Skip to main content

Advertisement

Log in

Effect of smoking status on coronary artery disease among Chinese post-menopausal women

  • IM - ORIGINAL
  • Published:
Internal and Emergency Medicine Aims and scope Submit manuscript

Abstract

Smoking is a prominent risk factor of cardiovascular diseases. The occurrence of myocardial infarction and mortality in smokers with cardiovascular diseases is several times higher than that in non-smokers. Smoking is associated with gender-independent enhanced mortality. We determined the effect of smoking status on coronary artery disease (CAD) and coronary computed tomography angiography (CCTA) in Chinese post-menopausal women. Among these patients, those with significant CAD (≥50 % luminal narrowing) were further classified into one-, two-, or three-vessel disease according to CCTA results. The following events were recorded: all-cause mortality, non-fatal infarction and unstable angina. 2332 patients evaluated with CCTA included 1668 never smokers (71.5 %), 475 former smokers (20.4 %), and 189 current smokers (8.1 %). The current smokers exhibit greater luminal narrowing as observed on CCTA (p < 0.001) than the other subjects. During the median 685 ± 269.8 days follow-up period, never-smoking women have a low incidence of events, whereas former and current smokers are associated with an increased incidence of such event (p < 0.001). Furthermore, current smoking and the presence of multiple-vessel disease on CCTA are independently associated with the events in the logistic regression analysis. Smoking status is related to significant CAD and luminal narrowing on CCTA in the Chinese post-menopausal smoking women. In addition, current smoking and the presence of multiple-vessel disease on CCTA can independently predict events of all-cause mortality, non-fatal infarction or unstable angina.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Clarke R, Emberson J, Fletcher A, Breeze E, Marmot M, Shipley MJ (2009) Life expectancy in relation to cardiovascular risk factors: 38 year follow-up of 19,000 men in the Whitehall study. BMJ 339:b3513

    Article  PubMed  PubMed Central  Google Scholar 

  2. Benowitz NL (2010) Nicotine addiction. N Eng J Med 362:2295–2303

    Article  CAS  Google Scholar 

  3. Doll R, Peto R, Boreham J, Sutherland I (2004) Mortality in relation to smoking: 50 years’ observations on male British doctors. BMJ 328:1519–1528

    Article  PubMed  PubMed Central  Google Scholar 

  4. Shah AM, Pfeffer MA, Hartley LH, Moyé LA, Gersh BJ, Rutherford JD, Lamas GA, Rouleau JL, Braunwald E, Solomon SD (2010) Risk of all-cause mortality, recurrent myocardial infarction, and heart failure hospitalization associated with smoking status following myocardial infarction with left ventricular dysfunction. Am J Cardiol 106:911–916

    Article  PubMed  Google Scholar 

  5. Huxley RR, Woodward M (2011) Cigarette smoking as a risk factor for coronary heart disease in women compared with men: a systematic review and meta-analysis of prospective cohort studies. Lancet 378:1297–1305

    Article  PubMed  Google Scholar 

  6. Grundtvig M, Hagen TP, Amrud ES, Reikvam A (2011) Mortality after myocardial infarction: impact of gender and smoking status. Eur J Epidemiol 26:385–393

    Article  PubMed  Google Scholar 

  7. Grundtvig M, Hagen TP, Amrud ES, Reikvam Å (2013) Reduced life expectancy after an incident hospital diagnosis of acute myocardial infarction—effects of smoking in women and men. Int J Cardiol 167:2792–2797

    Article  PubMed  Google Scholar 

  8. Woodward M, Lam TH, Barzi F, Patel A, Gu D, Rodgers A, Suh I, Asia Pacific Cohort Studies Collaboration (2005) Smoking, quitting, and the risk of cardiovascular disease among women and men in the Asia-Pacific region. Int J Epidemiol 34:1036–1045

    Article  CAS  PubMed  Google Scholar 

  9. Jha P, Ramasundarahettige C, Landsman V, Rostron B, Thun M, Anderson RN, McAfee T, Peto R (2013) 21st-century hazards of smoking and benefits of cessation in the United States. N Engl J Med 368:341–350

    Article  CAS  PubMed  Google Scholar 

  10. Gaemperli O, Liga R, Bhamra-Ariza P, Rimoldi O (2010) Nicotine addiction and coronary artery disease: impact of cessation interventions. Curr Pharm Des 16:2586–2597

    Article  CAS  PubMed  Google Scholar 

  11. Luo J, Rossouw J, Margolis KL (2013) Smoking cessation, weight change, and coronary heart disease among postmenopausal women with and without diabetes. JAMA 310:94–96

    Article  CAS  PubMed  Google Scholar 

  12. van Werkhoven JM, Schuijf JD, Pazhenkottil AP, Herzog BA, Ghadri JR, Jukema JW, Boersma E, Kroft LJ, de Roos A, Kaufmann PA, Bax JJ (2011) Influence of smoking on the prognostic value of cardiovascular computed tomography coronary angiography. Eur Heart J 32:365–370

    Article  PubMed  Google Scholar 

  13. Versteylen MO, Kietselaer BL, Dagnelie PC, Joosen IA, Dedic A, Raaijmakers RH, Wildberger JE, Nieman K, Crijns HJ, Niessen WJ, Daemen MJ, Hofstra L (2013) Additive value of semiautomated quantification of coronary artery disease using cardiac computed tomographic angiography to predict future acute coronary syndrome. J Am Coll Cardiol 61:2296–2305

    Article  PubMed  Google Scholar 

  14. van Werkhoven JM, Gaemperli O, Schuijf JD, Jukema JW, Kroft LJ, Leschka S, Alkadhi H, Valenta I, Pundziute G, de Roos A, van der Wall EE, Kaufmann PA, Bax JJ (2009) Multislice computed tomography coronary angiography for risk stratification in patients with an intermediate pretest likelihood. Heart 95:1607–1611

    Article  PubMed  Google Scholar 

  15. Hadamitzky M, Freissmuth B, Meyer T, Hein F, Kastrati A, Martinoff S, Sheumig A, Hausleiter J (2009) Prognostic value of coronary computed tomographic angiography for prediction of cardiac events in patients with suspected coronary artery disease. JACC Cardiovasc Imaging 2:404–411

    Article  PubMed  Google Scholar 

  16. Chow BJ, Wells GA, Chen L, Yam Y, Galiwango P, Abraham A, Sheth T, Dennie C, Beanlands RS, Ruddy TD (2010) Prognostic value of 64-slice cardiac computed tomography severity of coronary artery disease, coronary atherosclerosis, and left ventricular ejection fraction. J Am Coll Cardiol 55:1017–1028

    Article  PubMed  Google Scholar 

  17. Min JK, Lin FY, Dunning AM, Delago A, Egan J, Shaw LJ, Berman DS, Callister TQ (2010) Incremental prognostic significance of left ventricular dysfunction to coronary artery disease detection by 64-detector row coronary computed tomographic angiography for the prediciton of all-cause mortality: results from a two-centre study of 5330 patients. Eur Heart J 31:1212–1219

    Article  PubMed  Google Scholar 

  18. Min JK, Dunning A, Lin FY, Achenbach S, Al-Mallah M, Budoff MJ, Cademartiri F, Callister TQ, Chang HJ, Cheng V, Chinnaiyan K, Chow BJ, Delago A, Hadamitzky M, Hausleiter J, Kaufmann P, Maffei E, Raff G, Shaw LJ, Villines T, Berman DS, Investigators CONFIRM (2011) Age- and sex-related differences in all-cause mortality risk based on coronary computed tomography angiography findings results from the international multicenter CONFIRM (Coronary CT angiography evaluation for clinical outcomes: an international multicenter registry) of 23,854 patients without known coronary artery disease. J Am Coll Cardiol 58:849–860

    Article  PubMed  Google Scholar 

  19. Russo D, Corrao S, Battaglia Y, Andreucci M, Caiazza A, Carlomagno A, Lamberti M, Pezone N, Pota A, Russo L, Sacco M, Scognamiglio B (2011) Progression of coronary artery calcification and cardiac events in patients with chronic renal disease not receiving dialysis. Kidney Int 80:112–118

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  20. Burger HG, Hale GE, Dennerstein L, Robertson DM (2008) Cycle and hormone changes during perimenopause: the key role of ovarian function. Menopause 15:603–612

    Article  PubMed  Google Scholar 

  21. Centers for Disease Control and Prevention (CDC) (1994) Cigarette smoking among adults-United States, 1992, and changes in the definition of current cigarette smoking. MMWR Morb Mortal Wkly Rep 43:342–346

    Google Scholar 

  22. Thygesen K, Alpert JS, White HD (2007) Universal definition of myocardial infarction. Eur Heart J 28:2525–2538

    Article  PubMed  Google Scholar 

  23. Bassand JP, Hamm CW, Ardissino D, Boersma E, Budaj A, Fernández-Avilés F, Fox KA, Hasdai D, Ohman EM, Wallentin L, Wijns W (2007) Guidelines for the diagnosis and treatment of non-ST-segment elevation acute coronary syndromes. Eur Heart J 28:1598–1660

    Article  CAS  PubMed  Google Scholar 

  24. Iversen B, Jacobsen BK, Løchen ML (2013) Active and passive smoking and the risk of myocardial infarction in 24,968 men and women during 11 year of follow-up: the Tromsø Study. Eur J Epidemiol 28:659–667

    Article  PubMed  PubMed Central  Google Scholar 

  25. Meyers DG, Neuberger JS, He J (2009) Cardiovascular effect of bans on smoking in public places. J Am Coll Cardiol 54:1249–1255

    Article  PubMed  Google Scholar 

  26. Pell JP, Haw S, Cobbe S, Newby DE, Pell AC, Fischbacher C, McConnachie A, Pringle S, Murdoch D, Dunn F, Oldroyd K, Macintyre P, O’Rourke B, Borland W (2008) Smoke-free legislation and hospitalizations for acute coronary syndrome. N Engl J Med 359:482–491

    Article  CAS  PubMed  Google Scholar 

  27. Shaw LJ, Raggi P, Callister TQ, Berman DS (2006) Prognostic value of coronary artery calcium screening in asymptomatic smokers and non-smokers. Eur Heart J 27:968–975

    Article  PubMed  Google Scholar 

  28. Ambrose JA, Barua RS (2004) The pathophysiology of cigarette smoking and cardiovascular disease: an update. J Am Coll Cardiol 43:1731–1737

    Article  CAS  PubMed  Google Scholar 

  29. Loria CM, Liu K, Lewis CE, Hulley SB, Sidney S, Schreiner PJ, Williams OD, Bild DE, Detrano R (2007) Early adult risk factor levels and subsequent coronary artery calcification: the CARDIA Study. J Am Coll Cardiol 49:2013–2020

    Article  PubMed  Google Scholar 

  30. Jockel KH, Lehmann N, Jaeger BR, Moebus S, Mohlenkamp S, Schmermund A, Dragano N, Stang A, Gronemeyer D, Seibel R, Mann K, Volbracht L, Siegrist J, Erbel R (2009) Smoking cessation and subclinical atherosclerosis-results from the Heinz Nixdorf Recall Study. Atherosclerosis 203:221–227

    Article  PubMed  Google Scholar 

  31. Mieczkowska J, Mosiewicz J, Sak J, Grzybowski A, Terlecki P, Barud W, Kwaśniewski W, Tutka P (2012) Effects of cigarette smoking, metabolic syndrome and dehydroepiandrosterone deficiency on intima-media thickness and endothelial function in huyertensive postmenopausal women. Med Sci Monit 18:CR225–CR234

  32. Conen D, Everett BM, Kurth T, Creager MA, Buring JE, Ridker PM, Pradhan AD (2011) Smoking, smoking cessation, and risk for symptomatic peripheral artery disease in women: a cohort study. Ann Intern Med 154:719–726

    Article  PubMed  PubMed Central  Google Scholar 

  33. Naghavi M, Libby P, Falk E, Casscells SW, Litovsky S, Rumberger J, Badimon JJ, Stefanadis C, Moreno P, Pasterkamp G, Fayad Z, Stone PH, Waxman S, Raggi P, Madjid M, Zarrabi A, Burke A, Yuan C, Fitzgerald PJ, Siscovick DS, de Korte CL, Aikawa M, Juhani Airaksinen KE, Assmann G, Becker CR, Chesebro JH, Farb A, Galis ZS, Jackson C, Jang IK, Koenig W, Lodder RA, March K, Demirovic J, Navab M, Priori SG, Rekhter MD, Bahr R, Grundy SM, Mehran R, Colombo A, Boerwinkle E, Ballantyne C, Insull W Jr, Schwartz RS, Vogel R, Serruys PW, Hansson GK, Faxon DP, Kaul S, Drexler H, Greenland P, Muller JE, Virmani R, Ridker PM, Zipes DP, Shah PK, Willerson JT (2003) From vulnerable plaque to vulnerable patient: a call for new definitions and risk assessment strategies: Part I. Circulation 108:1664–1672

  34. Park JW, Lee SY, Kim SY, Choe H, Jee SH (2008) BMI and stroke risk in Korean women. Obesity (Silver Spring) 16:396–401

    Article  Google Scholar 

  35. Atsma F, Bartelink ML, Grobbee DE, van der Schouw YT (2006) Postmenopausal status and early menopause as independent risk factors for cardiovascular disease: a meta-analysis. Menopause 13:265–279

    Article  PubMed  Google Scholar 

  36. Hong JS, Yi SW, Kang HC, Jee SH, Kang HG, Bayasgalan G, Ohrr H (2007) Age at menopause and cause-specific mortality in South Korean women: Kangwha Cohort study. Maturitas 56:411–419

    Article  PubMed  Google Scholar 

  37. Holahan CK, Holahan CJ, North RJ, Hayes RB, Powers DA, Ockene JK (2013) Smoking status, physical health-related quality of life, and mortality in middle-aged and older woman. Nicotine Tob Res 15:662–669

    Article  PubMed  PubMed Central  Google Scholar 

  38. Russo D, Morrone LF, Errichiello C, De Gregorio MG, Imbriaco M, Battaglia Y, Russo L, Andreucci M, Di Iorio BR (2014) Impact of BMI on cardiovascular events, renal function, and coronary artery calcification. Blood Purif 38:1–6

    Article  PubMed  Google Scholar 

  39. Whincup PH, Gilg JA, Emberson JR, Jarvis MJ, Feyerabend C, Bryant A, Walker M, Cook DG (2004) Passive smoking and risk of coronary heart disease and stroke: prospective study with cotinine measurement. BMJ 329:200–205

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  40. Rossi M, Negri E, La Vecchia C, Campos H (2011) Smoking habits and the risk of non-fatal acute myocardial infarction in Costa Rica. Eur J Cardiovasc Prev Rehabil 18:467–474

    Article  PubMed  Google Scholar 

  41. Jefferis BJ, Lawlor DA, Ebrahim S, Wannamethee SG, Feyerabend C, Doig M, McMeekin L, Cook DG, Whincup PH (2010) Cotinine-assessed second-hand smoke exposure and risk of cardiovascular disease in older adults. Heart 96:854–859

    Article  CAS  PubMed  PubMed Central  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Jinling Ma.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Statement of human and animal rights

The study was conducted according to the ethical standards of the two hospitals and national research committee and with the 1964 Helsinki declaration and its later amendments. The study did not involved animals.

Informed consent

Each patient provided written informed consent at baseline.

Additional information

J. Ma and X. Wang are co-first authors.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Ma, J., Wang, X., Gao, M. et al. Effect of smoking status on coronary artery disease among Chinese post-menopausal women. Intern Emerg Med 11, 529–535 (2016). https://doi.org/10.1007/s11739-015-1334-1

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11739-015-1334-1

Keywords

Navigation